Synopsis

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• Malignant spinal cord compression – This is considered an oncologic emergency. It is due to extradural tumor compression. 5%-10% of patients with cancer will experience spinal cord compression; the most common cancers responsible are lung, breast, and prostate cancers, and the most common sites of involvement are the thoracic spine (70%) followed by the lumbar spine (20%) and the cervical spine (10%).
• Spinal epidural abscess – Often presents with midline back or neck pain, fever, and weakness and may progress to irreversible motor and sensory deficits if not promptly treated. Risk factors include immunodeficiency, intravenous (IV) drug use, and impaired skin integrity (including recent surgery). Commonly implicated organisms include Staphylococcus aureus, gram-negative bacilli, Streptococcus, anaerobes, fungi, and tuberculosis-causing Pott disease.
• Spinal epidural hematoma – Hemorrhage into the epidural or subdural space causes acute focal or radicular pain followed by symptoms of spinal cord compression. Risk factors include trauma, therapeutic anticoagulation, and underlying blood dyscrasias. Spinal epidural hematoma may be a complication of lumbar puncture or epidural anesthesia.
• Hematomyelia – Hemorrhage into the spinal cord itself, resulting in acute painful transverse myelopathy. Risk factors include trauma, vascular malformations, vasculitis due to systemic lupus erythematosus or polyarteritis nodosa, bleeding disorders, and spinal cord neoplasms.
• Degenerative spine conditions, especially cervical spondylosis; ruptured disks; and trauma with bony dislocation.